Approximately 2% of pregnancies are complicated by dia-betes that either develops during pregnancy (gestational diabetes) or was antecedent to pregnancy (pregestational diabetes mellitus). In either case, diabetes has significant impli-cations for mother and fetus during pregnancy, and, conversely, pregnancy significantly affects diabetes. Whether diabetes isnewly diagnosed or long-standing, intense management may be stressful, and all those involved with obstetric care should be mindful of the extra emotional attention many of these patients need.
The American Diabetes Association (ADA) identifies three forms of glucose intolerance:
Type 1 diabetes mellitus refers to diabetes diagnosedin childhood. It is thought to be caused by immunologic destruction of cells of the pancreas, resulting in necessary insulin replacement. Diabetic ketoacidosis (DKA) ismore common in patients with this type of diabetes
Type 2 diabetes mellitus is adult-onset glucose intoler-ance. Patients with type 2 diabetes mellitus are frequently overweight, and the disease can often be controlled with weight control and a carefully followed diet. This type of diabetes is thought to result from insulin resistance and exhaustion of the cells, rather than their destruction.
Gestational diabetes mellitus (GDM) refers to glu-cose intolerance identified during pregnancy. In most patients, it subsides postpartum, although glucose intol-erance in subsequent years occurs more frequently in this group of patients.